Customer service needs to be a priority in health care

What do Enterprise Rent-a-Car, KeyBank, and the Cleveland Clinic have in common?

They all make customer (patient) satisfaction a top priority.

They accomplish this in industry-specific ways, but together their emphasis on service as a passion shares common themes:

1. Buy-in for a service culture comes straight from the top, and permeates the entire organization.
2. Copious resources are delegated to building a service culture, starting with hiring.
3. Employees are “hired for fit.” If a prospective employee doesn’t radiate service, they are re-directed.
4. Employees are brought into a culture that leads to their growth, values their opinions, and develops their leadership potential.

Andy Taylor, CEO of Enterprise Holdings, inherited the business from his father Jack, and has built it into a mega-brand. Enterprise currently manages the largest fleet of cars and is the single largest purchaser of vehicles in the United States.

He attributes the company’s growth and his own success to the service principles he inherited from his father. Managers at Enterprise are not promoted unless the get “top box” scores on customer service questionnaires (i.e. a 5 on 5-scale), even if they run their branch at a financial profit.

Enterprise trains its employees to “go after loose balls” as a matter of principle. When a customer comes in at lunch, for example, clerks will jump up to help and literally compete for the chance to serve the customer. At the recent Summit on Patient Experience at the Cleveland Clinic, Taylor told of one branch manager who alerted 9-1-1 when a customer fainted in the parking lot, and rode along with the ambulance to the hospital until the patient was stabilized and the family arrived.

That type of service excellence is de rigeur at Enterprise, according to Mr. Taylor.

In a time of tremendous uncertainty and lessening of public opinion in the banking industry, KeyBank has reaffirmed its promise to deliver top-level customer service.

KeyBank is the fourteenth largest commercial bank in the U.S. Beth Mooney, Vice-Chair at KeyCorp, explained that though polling data shows a loss of trust in the banking sector, poll respondents still implicitly trust individual bank tellers.

Mooney attributes this to the fact that KeyBank carefully screens employees for their customer friendliness proclivities. New hires are trained on sophisticated simulators that teach front-end employees how to handle just about any situation.

It’s not a coincidence that as a director on the Cleveland Clinic’s board, Ms. Mooney chairs the Patient Experience Committee, lending her insights from the business world to the world of health care.

In addition to careful hiring and a culture of service, these companies also make a concerted effort to recognize employees, both internally and externally. This creates a virtuous cycle of employees tooting each other’s horns to broadcast their service excellence to leadership and beyond.

Ms. Mooney related the story of a branch employee who helped an elderly couple with their finances for years. When the husband eventually died, the employee made sure to call the widow on Christmas morning, her first without her spouse.

When Ms. Mooney related this story to conference attendees, you could’ve heard a pin drop in the auditorium, after the collective audible gasps.

John Schumann is an internal medicine physician at the University of Chicago who blogs at GlassHospital.

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  • Laurie

    I got a survey after a horrible appointment with a physician assistant. I was undertreated, needed additional evaluation and ended up with permanent damage. The survey asked if everyone smiled, whether I had to wait, was the enviroment comforting. Good thing customer service is so important.

    • r watkins

      You left out whether the parking was convenient.

      • rwatkins

        And whether you were given extra ketchup with your fries.

  • jsmith

    Mere happytalk. This here troop will not be rallied. A better model is the airlines. Businesses constantly on the verge of starvation, constantly cutting corners, employees and consumers unhappy but carrying on because of no alternatives. Welcome to the present and future of primary care.
    Changing this bleak reality will require lots and lots and lots of money, money which is not forthcoming.

    • SmartDoc

      I agree. The democrat party state seizure of medical care will result in unimaginable nightmarish bad customer service in the real world.

      Cash only and concierge (I hate that adjective) practices will be the only limited locales where customer service quality control will be practiced.

  • rezmed09

    Wake up!!!! Customer satisfaction is only a priority for businesses if there is real competition for paying customers. Make people happy and you make more money – only if there is real competition and real money to be made.

    In many sectors, American medicine is devoid of real competition. Right now there are long waiting times to get appointments into PCP’s and many specialists. This is the reality. Many docs are “not taking new patients in your health plan.” Unfortunately for patients, physician satisfaction is the priority in many sectors of health care – especially the dying field of primary care docs.

  • BladeDoc

    Customer service IS important in medicine. However you continue to confuse the patient with the customer. Definition of customer – A person, company, or other entity which BUYS goods and services produced by another person, company, or other entity.

    The insurance company is the customer. The patient is the PRODUCT. This will not change as long as there is a 3rd party payer system.

    • Anonymous

      “Patient is the product.” What product would that be? Hope you’re not really a doctor.

    • Anonymous

      patient = customer (like it or not)

      no patient, no insurance company

      insurance companies are just the middle man and they would not exist if people (patients) would not purchase the insurance.

      you’re not treating the insurance companies; you’re treating the patients, who by the way pay for the medical insurance and in turn for the doctors’ fees.

  • r watkins

    A previous poster here told us that the University of Chicago charges $844 for the zoster vaccine. Those kinds of fees pay for a lot of customer service.

    • rezmed09

      Read what Bladedoc wrote. Who is doing the paying? that is the real customer. The patient is not actually paying $844. No the insurance carrier is, and they’re probably paying $200 instead.

      • rwatkins

        That was the fee quoted to a patient whose insurance did not cover the vaccine. My point is that the author of this post is writing from within an organization that can use market share/reputation to demand fees that are completely out of line with what most docs choose. See the reporting from Massachusetts on Partners.

  • family doc

    What patients (and many physicians) don’t realize is that the government or commercial payor is the customer, not the patient. When the patient is paying the bills, as in direct medicine, customer service is focused on the patient. When a third party is paying the bill, that payor’s rules are the focus of the clinic or hospital’s efforts.

    • Anonymous

      Come on! Doctors are not coerced into accepting the rules you mentioned. They do it b/c they want to, and then they complain about it.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    My comment here may not bode well for my “Grand Rounds” submission” this week, but I’ve been listening to this kind of tripe from people-in-suits since 1995. Physicians are “valued employees” (or “partners” – just without the benefits of partnership) playing on flashy “teams” . . . that is, until the honeymoon is over, the sun stops shining on the executive’s suite and the suits figure out that roses come with thorns.

    I do everything I can to provide very good/conscientious care to my patients and to provide a professional/comfortable atmosphere. But there’s just one REALLY BIG problem with the make-the-customer-happy-at-all-costs-theory (particularly in Pediatrics):

    The patient (“the customer”) is NOT always right.

    Oh, and people are not cars.

  • http://www.epmonthly.com/whitecoat WhiteCoat

    Exactly what happened when the employee at Enterprise got puked on, swung at, called every one of George Carlin’s seven dirty words in the first 15 seconds of the interaction and threatened with the death of his family by the customer?
    Oh yeah. That doesn’t happen at Enterprise. Conversely, it is a routine occurrence in emergency departments across the nation. What miserable employees we are for not instilling a culture of service by offering up my family and a Ginsu knife.
    How sweet that Cleveland Clinic calls their patients to check on them. Do you recommend that emergency physicians do that before, during, or after they are intubating your child? How many call backs should we make while the 40 patients wait for care in the emergency department waiting room?
    Oh, and when customers complain because KeyBank officers won’t approve a loan when a patient in no way qualifies for that loan, do KeyBank board members fire or threaten the employment of the loan officers for lack of service excellence? Didn’t think so. Yet if emergency department drug seekers aren’t given narcotic prescriptions or if we don’t write work notes for obviously well patients and those patients complain, nastygrams start flowing about how patient satisfaction scores better be brought up.

    There are certain industries that don’t fit the typical mold and you’ve just touched upon one of them, doc.

    That reminds me. My customer experience for this post was entirely unsatisfactory. Now where do I go to complain?

    • Matt

      “There are certain industries that don’t fit the typical mold and you’ve just touched upon one of them, doc.”

      Because physicians have allowed themselves to be commodities in exchange for more money, their industry is now looked at in much the same way Wal-Mart, rental cars, etc. are looked at – figure out a way to give the customer what he wants so he’ll come back and buy more.

      A profession doesn’t (or shouldn’t) have those goals. But because of the way physicians are paid that’s how they think. We are all somewhat conditioned to maximize our revenue per time worked. And physicians have fallen victim to that. Think about it – they don’t even get paid based on their skill, it’s a set rate per procedure. So the quality of your skills and the depth of your knowledge as a physician aren’t worth anything.

      There is no unhappier physician than WC, I imagine, but if you read his stuff, it’s because he has next to no control over his work he feels. His patients view him as a product provider, and not much more. His job is not to render advice and care to his patient, as an architect assists a client or a lawyer does, but to either fix the problem or send them to someone who can. And do so immediately at the lowest cost.

      To WC’s credit, this is still frustrating to him, as opposed to just laying back and playing the game. Now, he blames everyone else, and especially malpractice victims and their attorneys, but who else is he going to lash out at? The massive bureaucracy of a health insurer? His patients? His employer?

      I feel for him, and all of you stuck in this payment trap. You’ve missed a lot of windows to change this, and now I’m afraid it’s too late. I think the independent physician professional is a rapidly dying breed, only hastened by the recent healthcare bill.

      • Anonymous

        As a patient I’m terrified by the doctors’ comments on these site. Most of you seem so bitter. Why?
        You guys treat your profession as a business, but at the same time you think you;re way above the regular business people and you should get to do whatever you please, whever you please. For you, we the patients are just a dollar sign or some record number. However, from my perspective, since it is my body afterall, I would like to ensure that I am involved in the process and make sure that I do receive the best care possible.
        Also, your comments alude that doctors are always right, which is not the case since there are plenty of medical mistakes and people do die because of them.

  • r watkins

    It’s hard to believe that anyone with two Betz cells can hold up the banking industry as a model for the rest of us to emulate.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    White Coat, I am in love. Spot-ON comment!

  • http://www.twitter.com/alicearobertson Alice

    How sweet that Cleveland Clinic calls their patients to check on them. [end quote]

    Hmmm….we will have run up a bill of about a quarter million there this year for two family members, and the only call about customer satisfaction call we received was to get my husband involved in a cardiac-exercise program. In fairness, they do have a customer service form on their site, and I think I received one in the mail. I hear customer service has loads of complaints, but they do offer “World Class” care…um…. that’s a bit relative. Sometimes you receive it, and sometimes you don’t, and some doctors are excellent, and some are slouchers.

    The doctors under 40-45 years old seem much friendlier, and so do the women doctors. So far, we have only seen a few turkeys, but I am not big on making complaints because I think you should go to the doctor and work things out. When livelihoods are at risk we should tread carefully on what we report, but I will say some of my experience there is on the shocking level. We do have two doctors there that we love, and maybe a third….because the Clinic does attract some really talented people……but some of them suffer from that old malady..they are querulous humans….just like their sick patients.

  • http://febrifuge.blogspot.com Febrifuge, PA-C

    Before I switched careers, I was heavy into the customer-service mentality; at one point, I was a corportate trainer, relaying the message to the rank and file. There is a lot of very good, rather common-sense stuff that’s worthy of emphasis and repetition. But now that I’m in medicine, it’s blindingly obvious where there are critical, fundamental differences. Many of them have been stated well by my colleagues, above.

    Suffice to say, now that I know a few things first-hand about both spheres of activity, I am not impressed by the happytalk.

  • Dr. J

    Whitecoat and BladeDoc have it exactly. The customer is the one who pays for the service, and it pays to please the customer. At present that means we should strive to please the insurer or medicare. If the patient wants to be the customer that is awesome, and by all means lets move to a patient pay system where insurance is left for extraordinary rather than ordinary care. Then customer service and competition can enter a real market place.
    I would also like to propose that Enterprise be mandated to set up a program called EMTALAprise. The purpose would be that people who urgently need to rent a car could not be refused a care simply because they did not have the money to pay. Urgent need of a car is defined as the person says they urgently need a car. And just to be clear EMTALAprise better not cheap out and give me a Hyundi next time I crash my ride just ‘cuz I was wasted. I better get a Chrysler 300, and shine up those rims before I get in, I like to ride in style.
    I hope that won’t mess up their fine customer service.

    • SmartDoc

      Dr J, you are a funny person!

      And of course 100% accurate.

      • http://www.twitter.com/alicearobertson Alice

        That was witty……..but what if people become as responsible as this post suggests…….will the need for doctors go down?

  • http://www.heathero.com HeatherO

    As a patient/customer, I agree with the post. Perhaps the insurance co. pays the bill in many cases, but I still CHOOSE where to go! Therefore I choose where those dollars are spent. In fact, We just had my grandmother transported hundreds of miles to go to the best hospital (IMO). Medicare and Blue Cross may have paid the bills, but we decided who they paid :)

    I am curious though…I have heard that medicare payouts are now based at least in part to patient satisfaction, is that correct? If so, doesn’t that make a difference?

    Oh, and to the gentleman that mentioned that you should be using airlines as an example instead, I also agree. Look at Southwest. They have the best customer service hands down and reported a profit during the recession when the others were struggling :)
    http://goo.gl/fb/PzGxN

    • rezmed09

      Bravo Heather for taking the initiative. That is really the only way to improve the system – voting with your feet. But the bottom line is you are in the minority and little competition exists.

    • anon

      I would agree with you, except that, in my experience, I often do not have much of a choice of where to go. I may have a choice between the few different physicians that my crappy student insurance allows (in the small-medium sized city where I live), but then one or two of them wont be taking new patients, and another will have a 6 months waiting list, and then my choice will be made. So that decision is essentially made by my insurance company, and the reason that the insurance company chose that physician(s) is because of payment negotiations between the customer (insurance) and provider (physician). I’m just herded like a cow into the appropriate place (which is funny because that’s exactly how Southwest treats its fliers, albeit in a humorous and friendly way)

    • jsmith

      As a family doc, my profit is the pretty much the same whether I give good service or not. And I don’t give very good service, if good service means being prompt, because I mainly take care of acutely ill people, so the less sick simply have to wait. Seeing me is a good idea if you have chest pain. If you want to talk about vitamins, I’m probably not your guy, but can refer you to a nice nurse practitioner. I try give good medical care, which is a higher goal. Fortunately most pts understand the concept of triage and so I get very few complaints.
      Look, if America waits better service, train up a lot more of us. Oh, and be prepared to foot the bill.

    • Vox Rusticus

      Unfortunately your only choice, when you leave it to your insurer to settle your bill, is to decide whether to go to the doctor or not, and as long as more than one doctor is available to see you, to decide which one you will see. Your insurer pays the same, service for service wherever you go. You can’t vote your preference by paying more for someone whose practice you like better, unless you choose to forgo the terms of your policy and see someone out of your plan.

      This is where restoring the right to balance bill would restore the notion of real patient choice to the doctor-patient-payer triangle. Patients could then decide where to spend the coverage dollar and how much of the remaining charge they were willing to pay for the service they desired.

      Too bad neither the government nor the private insurance industry has much interest in that kind of choice.

  • http://www.twitter.com/alicearobertson Alice

    Ms. Mooney related the story of a branch employee who helped an elderly couple with their finances for years. When the husband eventually died, the employee made sure to call the widow on Christmas morning, her first without her spouse.[end quote]

    Without having the benefit of being there personally, I can only deduce some assumptions, which may very well be wrong. If they are I apologize.

    This seems more reflective of a genuinely kind-hearted human being, than anything about customer service. When a doctor does something beyond his job description that is kind I don’t give the corporation he works for credit, I realize I am dealing with an empathetic individual. Unless, the corporation mandates these type of actions, they are from the heart, and that’s a virtue, not really customer service.

  • http://www.linkedin.com/in/achievementstrategies Marie

    These caustic and bitter comments are incredibly unprofessional and disrespectful. They feed right into Dr. Schumann’s point. Health care is a service industry. We have to be the whole package. Yep, we get puked on, called names and have to clean up crap, literally and figuratively. But that is what we signed on for. And if you think differently, you are in the wrong line of work.

    I have said many times on this site that one of the major problems with health care in this country is a tolerance for mediocrity. Demanding a culture of customer service is not happy talk, it is the basic right of the people we serve, whether or not they are paying the bill. The assumption is they already are receiving top notch care from their providers, from all of you. I do not doubt you are giving your all medically. But patients also deserve respect and kindness from front line staff. They deserve explanations, apologies and options if they have to wait, either for an appointment or to see the doctor. They deserve correct billing and compassionate bill collecting. They deserve to be treated well and courteously by everyone they encounter in their health care experience. Even if they are rude, obnoxious or down right wrong. Sick people are not always nice, but we have to recognize that and rise above it. They are SICK, remember?

    And true, our patients are not cars. They are human beings. So why would anyone have an objection to a model of treating them with humanity?

    • http://www.heathero.com HeatherO

      I somehow missed your comment before. I agree 100%!
      Reassuring to know that everyone doesn’t share the ‘bitterness’ :)

    • http://febrifuge.blogspot.com Febrifuge, PA-C

      But Marie, I don’t think anyone is actually arguing against the efficacy or worth of the behaviors that comprise good service. Rather, I think the objection is to the idea that somehow a wonderful ‘customer’ experience is something that can be manufactured through means that drip with ‘corporate-speak.’ Especially when things like reimbursement (which allows providers to spend time with patients, keep the overhead expenses paid and the clinic doors open, etc) and working hours are not a part of the discussion.

      As I said before, the core principles of good service are worth reinforcing (and largely NOT mysterious or complicated). But the things that frustrate patients about our system are, by and large, the same things that frustrate providers. So fixing the fundamental issues seems like a better way to ensure a good experience – not the superficial, fluffy stuff.

  • http://www.heathero.com HeatherO

    wow! such bitterness…that explains a lot! Now I see why we ‘ve had to fight and fight for communication/ information from Doctors just to know what is going on.
    Pretty sad considering that I can only assume that at one time (when you originally chose to go into medicine?) you actually did so because you cared and wanted to help patients.
    Having worked in an ER and been a paramedic for 10yrs, I certainly don’t expect an ER doc to call every patient to see how their experience was. Clearly absurd.
    But there are patients who aren’t violent crackheads who are in the ER having one of the most horrible experiences of their life and they don’t deserve to be treated as if they are ‘a pain in the $%*’ for showing up there.
    Perhaps the issue here is the term ‘customer service’ and differences in how people define that.

    Maybe we should call it compassionate service?

    • http://www.epmonthly.com/whitecoat WhiteCoat

      Heather, your comments show a lack of knowledge about how the medical industry works. You just don’t get it.

      You’re right that some patients in the ED aren’t “violent crackheads” or drug seekers or people abusing the system so they don’t have to pay for a $1 pregnancy test. I doubt that any provider would have an issue with those patients. But our interactions with the patients who don’t abuse the system isn’t usually the yardstick by which we are judged, is it? The threat of “bad feedback” from violent patients and those who purposely abuse our system has changed the practice of medicine for the worse in this country. And all you can see is that some health care workers who are abused and spit at and have their jobs threatened are disillusioned with the system because they are chastised for providing appropriate medical care but can’t make every patient elated every time they think about coming to the hospital.

      If you’re so into “compassion” why don’t you publish your address here so Kevin’s readers can send you some of their violent patients whose restraints during their last emergency department visits caused them to have less than “satisfying” experiences. Maybe you could do some anger management and meditation with them over tea and crumpets. If you don’t want to have some of your own skin in the game, you’re being a hypocrite.

      While we’re on that line of thinking, violent criminals have problems, too. Why are we jailing them instead of providing a satisfying life to them by letting them work in daycare centers with our children?
      I wasn’t happy with my last speeding ticket. Should we now indict the legal system for its failure to satisfy me?

      What a horrible world we live in when everyone should be able to do whatever they want and we can’t hold others accountable for failing to satisfy them in every aspect of their lives.

      I look forward to your inability to address these issues while telling me how “bitter” I am because I dare to open your eyes to the real practice of medicine in this country.

      • Smart Doc

        WhiteCoat’s excellent efforts are useless against the professional entitement crew, who have no intention/capability of rational discourse.

  • http://dabeetsguide2em.blogspot.com/ Dabeet

    Heather O …Thank you!! I am so glad that I am not the only one that is disturbed by these posts. Great customer service makes your Job easier, that is the real reason to do it right. Customer service is not doing what the patient wants, scripting or anything else but empathizing with your patients. Please don’t lose your focus of why you chose a carreer in healthcare , it is a very difficult job ——if you are doing it for the money.

  • http://www.twitter.com/alicearobertson Alice

    Maybe we should call it compassionate service? [end quote]

    Um…but that wouldn’t really be accurate. We should not be deceived……customer service is there to help the corporation because it’s been shown that good customer service brings in more people. Satisfied customers tend to come back. We may benefit, and feel empowered, but ultimately, the decisions will usually be made about what is profitable for the hospital. The difference is the doctors are not deceived, but the patients are. The government is going to regulate, doctors feel more-and-more put upon, and the patients clap and think they will finally get the care they wanted (which, again, is relative….some patients want a butler…..some patients want to rant…….and some are just grateful the doctor looked them in the eye).

    I think doctors just feel stuck in the middle. Some of their contracts would border on severe. I know some doctors around here are being sued and can’t practice within a certain number of miles, and some up and left the minute they could because corporate medicine won’t allow them enough time with their patients (then blames them when mistakes happen, and mistakes go up when doctors have to limit their time, then customer service complaints go up and the customer is placated and the doctor is rebuked).

    The internet has not only empowered patients, but doctors can now rant (usually anonymously because some worry about their jobs). I am awestruck that patients have this type of forum to say what has been bubbling up inside them for years, and I do see some positive changes. I hope doctors are able to change some things to…now that they have a voice…..even if it’s a pseudonym.

  • DrB

    We docs have a hard time with discussion of customer-service based opinions of us, because we very often cannot “cater” to our patients’ wants and desires. We are not really like lawyers or car salesmen, or banks or rental companies, or really any other profession, simply because we are not trained or paid to “please the patient.” In fact, we often are paid to deliver hard truth to people; things they do not want to hear.

    I like the idea of providing compassionate care as the standard we should all be judged by, but this is quite subjective. Given two choices of docs: one who is ranked 1st in compassion and say, 10th in technical skills, and another who is ranked 10th in compassion and 1st in technical skills, who would you ask to operate on your child?

    • Matt

      That last thought is an interesting proposition. However, the public has no way of knowing who is first or last in technical skills because physicians won’t tell you anything about their colleagues, and they all get paid the same regardless of skills.

      • http://www.heathero.com HeatherO

        I don’t understand why they have to be mutually exclusive. I have experienced Docs who fall into each category and a select few who fall into both.
        Can you not be technically good AND say “I understand how you feel?”

  • http://www.healthecommunications.wordpress.com Steve Wilkins

    According to many of the physicians I hear from, if they don’t get paid for it or there’s not enough time…they don’t do it. “It” being presumably anything from providing recommended preventive care, and tying to understand where patients are coming from…to making sure that patients undertand what their physicians tell them to do.
    If there’s no time or reimbursement for actual clincal care….it’s probably too much to expect good customer service.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    I’ve just opened my Inbox after being up all night with sick kids/babies (all the while providing courteous/compassionate care) . . . and read some of these comments . . . and I’ve got to say my head is about to explode.

    Marie, Heather, Dabeet, et al, I LOVE WHAT I DO (or I for sure would not still be doing it). And I have NO OBJECTION WHATSOEVER to treating patients with humanity (I’d just like to see it returned in kind). I also understand (very well) that sick people can be frightened and lash out at people trying to help them.

    But I am sorry, being sick and afraid does NOT excuse (and does not explain) all of the things we are seeing these days in our offices and hospitals and ER’s. it does not entitle people to be abusive or violent.

    I was as idealistic as it gets when I got into this “business”. I was going to go home and give back. And I haven’t forgotten that brief, wonderful feeling. But it’s just now a long time ago and a galaxy far, far away.

    I’ve been in this blogosphere FOR FIVE YEARS blogging about the horrible/awful things that a “non-profit” hospital did to me (in my own hometown) in order to SHUT ME UP (after I intervened in a neonatal case another “most-favored” MD was botching and saved a very sick newborn’s life and reported what happened). My fight (which nearly put me into bankruptcy – and sucked my personal life dry) has NEVER been about the money – it’s about what this hospital did and got away with being totally, completely WRONG.

    I’ve signed my name from DAY ONE.

    I’ve BEGGED for help . . . i.e. some media attention and bad PR focused on the mill-town hospital that did me wrong, the local (pandering to the rich white guys running my county) DA that has buried the CRIMINAL case that I now have against hospital exectutives, and the state (North Carolina) & Federal government programs & regulatory bodies that let me swing in the wind.

    But instead of getting that help from lay-people/bloggers/journalists who no doubt would have expected me to do exactly what I did (especially if it were their child), I’ve been blown-off, insulted, called every name-in-the-book, told to “get over it” & “move one” and even cyber-stalked.

    And now I’m getting lectures on “customer service”?!?

    Puhlease. You can only push people so far into a corner before they come out of that corner swinging. And with Obamacare, we’re there.

    And YES!!!, I’m HUMAN and I’m frustrated and embittered and angry that medicine has turned into a cookie-cutter “industry” where MD’s are supposed to take every sling and arrow (professionally, financially, personally) and say nothing because that somehow makes us more “professional” and “compassionate”.

    Get real. And wake up. If you want good medical care, you are going to have to see to it that the people who are providing it (and who worked hard/trained for years to provide it) are happy/fulfilled in (and fairly compensated for) their work.

    And all this doctor can see – after TWELVE YEARS of being battered black & blue on the front lines of Pediatrics – and having her blood splattered all over medicine’s “white wall” – is that YOU DO NOT CARE about me.

    But you want me to KEEP BLEEDING for you. So far, I have. But I don’t know how much blood I have left.

    Respect, Marie, is a TWO-WAY street.

    • Anonymous

      “If you want good medical care, you are going to have to see to it that the people who are providing it (and who worked hard/trained for years to provide it) are happy/fulfilled in (and fairly compensated for) their work.”
      On this site specifically you guys complain about the money, as if you work nearly for free, which is NOT the case!

      “But you want me to KEEP BLEEDING for you. So far, I have. But I don’t know how much blood I have left.”
      I have not seen any doctors “bleeding” for their patients, but we see you people (doctors, hospitals, insurance companies, etc) sucking all our “blood” b/c you never seem to have enough money despite the fact that you people live very comfortable lives. If money is all you think about you should not be a doctor. Shame on all of you doctors who promote these type of enraged and deranged comments.

      • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

        Anonymous, your comment is a PERFECT example of why so many doctors on these threads are disgusted and embittered and angry. You clearly do not understand (or care – thank’s for making my point) what we go through/endure to get where we are and do what we do. If we do live very comfortable lives, it’s because we literally sold HUGE chunks of them in years of training and indentured servitued to do it. There should be some kind of decent pay-off at the end of all that. Yes? Yet, you lump us all into one big evil & greedy cabal and you don’t even sign your name.

        If you’ve read my blog (and I’ll give good odds you haven’t) then you know very well that money is NOT the only thing I care about – but it sure was something my tormenters-in-suits cared about. For years, I could barely scrape by and I’m a full decade behind where I should be financially because I answered a phone one night in the middle of the night and put a dying baby first.

        From another “enraged” comment I left at an NC blog discussing related issues (I’m talking to another Obama-loving blogger who likes to throw out the “deranged and crazy” ad homninems”):

        I’m here to remind Roch that I came home to Asheboro to serve-the-underserved. I took the loan-repayment deal (courtesy of the American taxpayer) and the crappy entry-level salary (i.e. NO bonus plan/NO incentives) and saw all comers and went way beyond above-&-beyond. We know what happened – that oversight in medicine AND Sam’s precious legal system is utterly broken. And we know that Roch could not give a tinker’s damn. I’m supposed to just suck up all the amoral/unethical/illegal things that were done to me and “move on”.

        But Roch wants doctors to BLEED for him/his socialist notions of how the world should be.

        I did not cause this problem and neither did Joe. I was dumped into it. And I’ve fought the battles that were important to me (mostly to survive) only to have people like Roch Smith Jr and Jeff Martin (for the uninformed here at Kevin’s, he was my cyber-stalker) call me “crazy” or “evil”.

        We physicians are not the enemy and we are tired of being treated like dirt.

        Enough.

        • http://www.twitter.com/alicearobertson Alice

          Mary I do truly feel bad for your pain, but on-the-other-hand you know there are moms/patients like me who doctors have harmed (maybe irreparably). I, too, am hurt, but we are both dealing with doctors who covered up (I am certain another doctor caused my daughter’s cancer to spread through his misdiagnosis [twice]. In a few weeks she needs her level 2, 3 and 4 lymphs removed, and we still have more to deal with). I completely understand your disgust and hurt (when your child is hurt, it’s not just anger, but devastating, spirit crushing heartbreak. You deal with wondering if you failed to protect your child from harm……knowing I couldn’t). Unless you have personally experienced that type of pain trying to rally the troops, or asking people unfamiliar with your situation or pain isn’t really going to help. There are organizations like MADD that started from pain, and then others who experienced that type of pain joined the ranks, and they have been very helpful. Is there an organization that could help you at all? I know you have exhausted your options, but as an educational tool it’s helpful to know what is available to both injured patients and doctors. I have little faith in any state organizations or peer reviews because a jury of their peers (i.e. other doctors) just isn’t going to help. Even if you offered a type of diplomatic immunity they would still need to face their other colleagues as a type of “rat” because as much as doctors rally against management, paychecks, student loans (which is useless because just about every person I know is dealing with these exact same nuances, so they wonder why doctors feel so privileged and the stereotype continues), rarely will doctors rally against other doctors. I find that curious……shouldn’t we go to the root of the problem and fix it from there? Pruning patients then expecting real results won’t help the real problem.

          Sometimes the sad fact is that tragedies…..travesties…..happen, and we do what we can to prevent it from happening again, but to expect justice for ourselves just isn’t going to happen. How can a family find justice if their child is run over by a drunk driver….or a doctor does irreparable harm? A lawsuit cannot restore what you have lost, so you try to help others, and I really do believe that’s what the posters are trying to do. Unfortunately, I have noticed doctors will rant, but rarely explain……when the masses get antsy the doctors quit posting. I wonder why people dedicated to working with the public to bring healing aren’t able to communicate well (communication is two-way……not just a one-way rant). The patients seem willing, and able, and desiring of relationships with you…….why the shut-down when you are usually posting anonymously (I know Mary doesn’t because she has a cause……but overall doctors who post here have a strong need to stay anonymous…….and so does a lawyer whose input I really like. And, oddly, usually the doctors answer him. Hmmmm………)

          • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

            Alice, you’re talking to someone who never had the opportunity to have a child – because her life was turned to trash by very greedy businessmen who appear to be covered in Teflon. Despite your pain, I envy you your daughter. Enjoy her. Love her. Cherish her. FIGHT for her. I’m very sorry one or two or more of my kind let you down.

            But I do not accept that justice is some abstract concept that most of us don’t have a shot at. And I WILL NOT accept that the system is what it is and cannot be fixed.

            I’ve acutally not exhausted all of my options. It is very likely that, by the end of the year, I will filing a lawsuit against the regulatory bodies and government agencies that let me swing. The sad thing about that is that if any of these agencies had done their job – or would do it now – this would not be necessary.

            Generally every organization/movement starts with one person who will not sit down/shut up – who will not take “no” or “that’s the way it is/get over it” for an answer.

            Having been through what I’ve been through, I totally understand why doctors post anonymously or under pseudonyms. Talk back to the powers-that-be (anywhere) and you have a target on your back (I have an online friend – a lawyer – who has endured no end of crap courtesy of the NC State Bar because she had the audacity to run for judge as something other than a cookie-cutter candidate). But these anons do not seem to understand that the blogosphere is, most of all, an ECHO chamber – and that the only people who ever changed anything were people who put it all out there – starting with their names.

            Doctors have got to realize that our “advocacy” organizations are not really advocating – for us or for our patients. And we’ve got to re-group.

  • http://www.heathero.com HeatherO

    Dr. Johnson, I DO care. I may not be a doctor, but I have worked in healthcare. I have seen both sides, and I am HERE reading this blog, not patient blogs because I respect the fact that there is change needed on both sides. I am sorry to hear about your experience. (I would be happy to do my part to share the word). You should be supported, and there is no excuse for the way that you have been treated, or for the way that many doctors and nurses treat patients.

    There are many great ones, don’t get me wrong!
    And as someone pointed out in this thread…they need to feel fulfilled. The bottom line is that no ONE of us can change the healthcare bill, insurance policies or payouts, etc. But re-connecting to the patient and why you became a doctor, and choosing be compassionate is where fulfillment comes from. That is one of the few things that we can control.

    (Oh, and telling people what they don’t want to hear is showing compassion as well. Provided that it is delivered in a compassionate way)

    just my 2 cents ;)

    • http://www.heathero.com HeatherO

      Oh and btw, ironically, I live in NC

      • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

        If you live in North Carolina, start writing the big newspapers in Raleigh and Charlotte and Greensboro and ask them WHY they have not covered this story – one that they ALL know about but have buried/ignored, only to waste boatloads of good newsprint on the trials and travails of John & Elizabeth Edwards . . .

        . . . you know, the ex-malpractice lawyer with a house in Orange County bigger than some small countries.

  • http://www.twitter.com/alicearobertson Alice

    I have not used customer service at our hospital (I was contacted by the Ombudsman when the doctor filed, and went through the peer review process), but I have what I believe is a form of lone ranger customer service. When I see an employee go above-and-beyond their service I try to e-mail them, or tell them personally how grateful I am, and write out a quote and give them a card with a Starbucks gift card enclosed. I send e-mails to doctors and tell them what I have observed that I think will be helpful in their quest, and that I am grateful for their kindness towards my daughter. A relationship is built from that. A few times I have sent an apology note for a faux pas, but the doctors usually respond that they didn’t view it that way (I have three teen daughters I take with me everywhere and they are very quiet while in the office……..then when we get to the car they critique my *performance* and sometimes they are right, so I write a note of gratitude and apology).

    I believe the motto that change begins with me, is usually a good place to start…….and then communication is built from there (knowing some doctors will act like the mere mortals they are, and some patients are tyrannts…..but overall I believe both parties can work together).

  • Michael Rack, MD

    “As a patient I’m terrified by the doctors’ comments on these site.”

    No need to be scared. Although many of us doctors are bitter about the healthcare system in this country and like to complain, when we are in the exam room with an individual patient we try to deliver good compassionate care to that patient.

  • http://www.twitter.com/alicearobertson Alice

    The threat of “bad feedback” from violent patients and those who purposely abuse our system has changed the practice of medicine for the worse in this
    country. [end quote]

    I think both your feedback and Heather’s is invaluable…because you are right…even if they are a minority the abusers hurt medicine for both the patients and doctors…..but on the other-hand so does the rating system that doctors “doctor” by only taking very healthy patients in an effort to boost their scores (I believe the wonderful author/doctor Jerome Groopman has something like a “D” rating, because he will care for the unhealthy. You just shake your head at the irony of a ratings system that actually praises doctors who refuse treatment to those who need it the most). People on both sides are playing a type of loaded poker game and those interested in helping people get well are constrained. Part of this is the government paying for healthcare (why people can’t see the downside to this is beyond me…….what seems like a humanitarian move to help a few becomes a free lunch to the masses and, although, we can point to the few it helped, more get hurt and both sides).

    I think patients are witnessing the frustration of doctors who want to treat patients, but feel a bit abused themselves. While many patients feel neglected. It’s what happens when patients and doctors behave badly, and fight a type of Goliath………so we are trying to define exactly what Goliath is made of, and hopefully, battle together. If we keep focusing on a small portion of badly behaving doctors/patients we miss the larger scope of actually being productive.

  • http://www.twitter.com/alicearobertson Alice

    But I do not accept that justice is some abstract concept that most of us don’t have a
    shot at. And I WILL NOT accept that the system is what it is and cannot be fixed [end quote]

    That’s great and I will cheer you on….my struggle is with how to be most effective. Personally, I am trying to see a larger vision and the people I can help the most… because in my own personal situation I can never get back what has been lost……..just trying to help prevent someone else from suffering the same. That’s my form of solice….because justice will elude me. If one chooses to be a type of whistleblower they will be hurt from just about every angle….but focusing on the larger angle of who is being helped is of great gain (and will be costly).

    I think using your voice via the internet is profitable. You have an open audience because as much as we need doctors the vast majority of people have a disdain for them (until they need them…..and right now I desperately need them………I have friends in academia who literally hate doctors……..I don’t hate doctors…..I have been through some hard times with them and see them as human beings with all their frailties and virtues, constrictions…convictions, and recently some valor. I am reading the book Complications by Atul Gawanda…what a mixed bag of emotions that book will evoke. He is a wonderful doctor…like Dr. Groopman…and both of these men will help restore our confidence in medicine through their honesty that medicine is a not a perfect science, nor really a fine art…each patient is different and a lot of guessing goes on, and many more mistakes than we all want to admit. Just because a patient survives doesn’t mean everything was done right. Human judgement is still a large part of the whole scenario…so pray you get a very good doctor if you need one………and I believe we have found one and tell him so. These authors write in a calm, humble manner, and are not defensive about their errors or the problems in medicine. I am sure they have been raked over the coals…….but there has gotta be something in the water in Boston……um….maybe antidepressants [? ack! my usual sarcasm] because their writings are captivating to the heart of patients..and as long as the patients outnumber the doctors we do have a voice. Like a wife who says she just lets her husband think he is the boss……slowly that moniker will be true as the government becomes the real boss and, sadly, we the patients are letting that happen because we think we like having things paid for and regulation of who we consider the “priviledged”………a big loud silent sigh from Alice).

    When we are hurt on such a personal level….it’s so hard to see through the emotions. The doctors think my daughter and I are so stalwart…….but they don’t see my tears……I am so absolutely heartbroken that I have to watch my daughter suffer……..I have to keep focusing on recovery and gratitude.

    I completely understand your pain….and that you view your career as a type of child worth protecting. But I wanted you to know that when done right…..your writing……..is a tool…….I believe the pen is mightier than the sword (i.e. look at Stephen King’s non-fiction memoir where he writes about the man who hit him and nearly killed him. The man was let off easy. Mr. King writes that he realized the man was similar to a character from one of his crazy novels. Some say through Mr. King’s writings the man would have fared better in jail……….so Mary keep writing and sharing and helping others………it may be your road to vindication………which often comes in ways we didn’t anticipate….I will eventually share more).

    Oh Mary, we do feel your pain and wish we could help………..I simply don’t know how to…..and that’s the frustrating part of life in general, not just medicine.

  • http://www.linkedin.com/in/achievementstrategies Marie

    I still stand by every word I said. And Dr. Schumann is absolutely correct. The health care profession is obligated to adopt and foster a culture of service, not to get good ratings but because it is the right thing to do.

    I sense many of the commenters here have multiple axes to grind, so it diminishes the credibility of their response to the issue at hand. I am terribly sorry for those of you who have had draining and emotional situations to deal with. It is clear there has been an awful toll and that is downright unfair. I truly hope you find some reasonable resolution.

    However, Dr. Schumann’s point is correct. Anyone dealing with patients has to have a philosophy of excellence. Never saying it is not my job. Always looking for ways to serve the people we care for. At the last hospital I worked at I can give you a litany of mediocrity:

    * Patients misdirected when they ask where they are supposed to go in the huge and confusing complex because no one took the time to really determine where they needed to be. Hospital jargon is confusing and if the patient used the wrong word, they got sent to Timbuktu.
    * Registrars eating their breakfast at their workstations while registering patients who were NPO for bloodwork.
    * Staff dropping everything and going to lunch, even if there were 15 people waiting for service.
    * Patients who were waiting for hours in the ER treated with indifference to downright hostility when they questioned the wait.

    These are the kind of things that are currently tolerated and subsequently give us a bad reputation. These are the situations that leave lasting impressions on our patients and send a message that no one really cares. Addressing these behaviors is not fluff.

    Chronic complainers are always going to be around, but they can be weeded out from the genuine reports of problem behavior. Holding our employees to a higher standard is good business but more importantly it is our obligation.

    • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

      Marie, with all due respect, I stand by everything I’ve said here too. And given the things that I’ve been through for the sake of that “philosophy of excellence” you extol (ergo, I have LOADS of credibility on this subject), I am NOT inclined to be lectured by over-paid executives who, more oftentimes than not, are invested in “customer service” and PR (but mostly profit) to the point of accepting/even encouraging medical mediocrity or even out-right covering up malpractice.

      In my case, these suits still have jobs – despite committing CRIMES (white-collar crimes – but crimes nonetheless). The doctor who did the right thing got burned and her patients lost a doctor suddenly and without true explanation. Something is WRONG with that. The system that allowed it to happen MUST change! If you think that’s an ax to grind, well, stand back. I’m grinding. It’s Independence Day, after all.

      I’m tired of people (particularly bloggers or journalists) “hoping” I find resolution – without doing anything to help or insist that it be so – or asking why it isn’t.

      My life/career/reputation in my own hometown was butchered by a gang of “team players” – and it all started because I said “NO” to a “right person” when the absolutely right answer was NO. She flew-off-the-handle and the rest is history.

      I’ve got no problem with high standards (and you’re right, the things you describe merit improvement – but perhaps after closer examination of the underlying pathology), and service is what we’re about. But I am sick and tired of the “anything goes” mentality that lets patients do/say whatever they want – even when they are very wrong . . . the mentality that would have medical providers be mindless/silent/submissive drones/doormats.

      It is NOT my job to be threatened or libeled or abused or assaulted or worse whilst doing my job – or FOR doing my job. And losing my job for doing it the right way is just unacceptable.

      Moreover, my services are NOT free.

      Now. If you will excuse me, I’m on-call far-from-home this 4th (as I usually am every 4th). It’s been a busy week and I’m going to prop my feet up and watch the Boston Pops – on TV with a glass of iced tea.

  • http://www.heathero.com HeatherO

    Alice and Marie, you both make really worthy points.

    Everyone here is ‘looking through a separate lens’. While some here are convinced that their way is the only way of looking at things, it is simply not true.
    I have seen BOTH sides of the hospital. A view that many here don’t have. My points aren’t intended for the select few. Yes, there are those who abuse the system, and providers, etc. I’ve been threatened, and puked on and cussed out. Most times without the safety net of an ER staff or security.

    The truth is however, that the majority of the world actually doesn’t have a disdain for doctors – unless they have been treated badly by one! Most actually believe that doctors care, until proven otherwise.
    Barring those who hop on the ambulance to go to the ER because they ran out of welfare money and need a warm place to sleep, and the like, the majority of patients in the HOSPITAL aren’t there by choice. Those who are truly sick did not ask to be, nor did their families.
    Each and every doctor, nurse and technician in the hospital DID choose to be there.
    Many of you have every right to be angry. You do however have the choice to not take it out on patients that don’t deserve it.
    I’m not talking about being nice VERSUS being competent. I’m suggesting that you can be both.
    I walked into a hospital room last week and witnessed my grandmother struggling to breathe with a RR of 48/pm and watched my aunt push the call button only to hear the sound of the phone being picked up and then hung up. I saw this happen 3 times in 10 minutes before I went down the hall looking for help and watched 2 nurses dart around the corner. The explanation later given was that the nurses didn’t like my aunt because she asked too many questions and was intimidating. Seriously???
    So an 80yo woman has to lie there gasping for air because grown women who chose to be nurses and who were getting paid to be there simply refused to come.
    There simply is NO excuse for that.

    When I talk about service and compassion, I’m not talking about throwing a party or even making follow up calls. I’m talking about common courtesy and care.

    Anyone can choose to zero in on every ‘bad apple’ that they want to in order to justify their position. There are plenty of those out there! There are certainly plenty of things in the healthcare system to complain about, and I’m for doing whatever we can to change them. But in the meantime, remember that each and every day those truly sick patients that did nothing to hurt you are there because they are counting on you.
    They will never forget you. Good or bad, you get to choose how they will remember you. No matter what the satisfaction ratings say, or what dollars are in play, your choice affects both you and them as human beings.
    That may sound fluffy, and you may not be able to take it to the bank, but it absolutely impacts your own fulfillment.

  • W

    <>

    Where exactly does this fairy-land exist where patients are free to speak without consequences? The same administrative forces you rile against have no qualms about “disciplining” a patient foolish enough to voice concerns. Some brush off these actions as the inevitable result of lawsuit fears. If so, it apparently takes very, very little to scare you.

    Every time any of my doctors has signed me up for a test or a procedure or a medication, I’ve complied, paid the bill, followed through — not always understanding why the test was ordered or what the medication was supposed to do, but generally assuming that the medical professional knows best. I live in a city monopolized by one mega-clinic whose “customer service” is universally reviled, but we have no choice. Nevertheless, in only one instance did I complain.

    And for that I now have to cross four counties to find a specialist who’ll take my insurance (oh, did I mention that the mega-clinic owns the insurance company? And that it’s the only insurance option available through most employers in town? Sweet deal, that.)

    Statements were also added to my permanent medical record by the clinic’s risk management attorney that make vague accusations in a similar tone one might use to condemn serial rapists and axe murderers. Said attorney never specifically states my crime — I imagine “he wrote a letter to Patient Relations that we didn’t like” would sound like a pretty flimsy justification for the BS that ensued — but she does do an impressive job of characterizing me as the worst kind of reprobate, considering the lack of supporting facts she had to work with. It may have helped that she conveniently left out my history of charitable donations to the clinic…which have subsequently ended. It took a few years, but the clinic finally stopped asking for more, more, more. (“We are very sorry you feel the way you do, but please think of the children your money can help…”)

    I’d always assumed that patients and medical staff alike where pretty much under the thumbs of these ethically challenged administrations, and I sympathized with the doctors and nurses who must put up with it daily. But if docs are going to start pointing fingers at me…well, don’t be too surprised if there’s one pointing right back at you someday.

    What’s that line sometimes attributed to Ben Franklin? “We must all hang together, or we will most assuredly all hang separately”…

    • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

      W, the fingers were pointed at me twelve years ago (by an ethically-challenged administration that suffered NO CONSEQUENCES for what they did – in fact, all the executives got raises). And I LOST MY JOB for it.

      I live and work in “fairyland” every day.

      My small/Southern hometown is dominated by one hospital (you might call it a “mega-clinic”) beholding to another bigger hosptial on thirty miles up the road. They are the biggest employer in town (next to the mills) and the executives can do ANYTHING they like – will full cover of the town’s big guns and the newspaper. Their reputation is horrible – and they’ve only made it worse by the stunts they’ve pulled with doctors and practices – but NO ONE holds them accountable. I’ve been on the Internet for FIVE YEARS and no one had done anything.

      So I’m feeling you pain.

      I’m also feeling you pain with regards to attorneys. The very LAST place you’re going to find the whole truth of anything is in a Courtroom.

      Do you think that patients did not complain when I was crap-canned? Do you think I did not go to DHHS and JCAHO?

      It’s always amazed me that a patient complaint can literally put a hosptial on probation or shut it down. But notsomuch when a doctor is on the other end of the phone. I went to JCAHO – twice – and both times I was told that they did not have a mechanism in place to deal with my kind of problem. Moreover, in the decade since, they’ve yet to develop one . . .

      . . . except to call physicians who complain “disruptive”.

      I agree that patients and doctors have got to stick together against the forces that are ripping medicine to shreds – but first we must meet in the middle.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Heather, I’ve NEVER said, in ANY of my comments, that mine was the only way of looking at things. But if you are going to really fix medicine, we’ve got to get away from the notion that the “customer is always right”.

    Moreover, I am tired of being told to “sit down/shut-up/get-over-it/move on” about what happened to me – in large part because of warped notions about what customer service should entail. The “no-credibility” bit REALLY burns.

    Hospitals are NOT hotels or Walmart. I am not a maid or a doormat. The customer/patient deserves my conscientious service (and my “customers” get that). I DON’T EVER “take it out on patients who don’t deserve it”.

    But maybe, just maybe the patients-who-don’t-deserve-it need to start CARING about the doctors-&-nurses-who-don’t-deserve-it, and DO SOMETHING about the patients-who-DO-deserve-it (that is, apart from standing by and allowing healthcare reform to pass that doesn’t touch the things that really need to be reformed).

    I’ve lost count of the times I’ve been sitting at a nurse’s station working on charts and a teenager in hotpants (not even a patient – just visiting one) comes to the desk to demand that I fetch her a (free) Coke – and gets mad when the doctor don’t immediately get up and wait on her.

    And I won’t ever forget working in the ED one Saturday night . . . walking into a room only to be threatened with a lawsuit the second I came in . . . because I did not see the obese-beyond-words/unemployed GrandMother (working on her free courtesy fried-chicken meal) and the child-with-a-cold she brought in (by ambulance-taxi) . . . the second she walked in the the ED door hours earlier (the kids in other rooms with meningitis and asthma and broken bones be damned). She didn’t “have time” to take the child to his primary care physician during the day. And I was the devil before I could say, “Hello”.

    I did my job (it wasn’t the child’s fault) through gritted teeth and a plastered-on smile, but came out of that room wondering, “What am I doing here and WHY am I doing it?”

    There is something VERY WRONG with the expectations that the public has . . . what it has tolerated and condoned and rewarded for so long . . . and the sense of entitlement that it has bred.

    You tell me that I am basing my opinion on my bad experiences (ergo I have no credibility???), but what are YOU doing?

    I’m sorry about what happened to your GrandMother. I see you complained. Good.

  • http://www.twitter.com/alicearobertson Alice

    I’m not talking about being nice VERSUS being competent. I’m suggesting that you can be both. [end quote]

    You are right it shouldn’t be an either/or type of situation, and I believe the gist of the article was about courtesy from employees (and Mary is right they are not volunteers, they are a paid-for service, so customers have a right to have an expectation from a doctor to be well-mannered……I struggle with the empathy because I tend to think some people just have it….and yet……prisoners who care for animals become more empathetic…..maybe some volunteering would be a good requirement for doctors? John Gatto [who wrote about the "Dumbing Down" of America] required 20 hours a month of volunteering from his students. The positive changes in the students makes it well worth it]. I actually think if one is able they should volunteer somewhere, and for your teens it’s invaluable because it teaches people to see beyond their own bubble. My teens work with Alzheimers patients, and we were volunteering in the ghetto…..that was a bit scary at times though…..but invaluable. And we volunteer at a political think tank because I think it’s good to be passionate about at least a few things, we go into the innercity to comfort animals at the shelter. I think we get as much out of it as we give).

    The bottomline was summed up in the book How Doctors Think when he said every single doctor he interviewed said if there was not a connection between a doctor and themselves they would hit the road and the sooner-the-better. The example given about skills was worthy, but surely skills don’t give a doctor the privilege of being arrogant? That may be a customer service issue…………….and a doctor may very well need humbled because arrogance is something other doctors just won’t put up with.

    In the book I am reading…Complications…he spends a whole chapter on the arrogance of doctors. They usually will not allow a resident to touch their family and if the resident does the resident treats the family member of a doctor differently. Odd that doctors defend residents, but don’t want them practicing on their own family members. Hmmmm……..a bit ironic and some hypocrisy thrown in there to.

  • http://www.healthecommunications.wordpress.com Steve Wilkins

    Dr. Johnson and others,

    Thanks for providing insight into the situations you face in a one
    hospital system town.

    Here’s a thought – find a blogger that focuses on the pertinent aspect of the industry, i.e., hospital, health plan, etc., and get them to tell your story without mentioning names and risking repercussions. As an old hospital Marketer, hospitals live in fear of bad press. Why not use “social media” to achieve a “social good?”

    Any other bloggers have any thoughts on this approach?

    Steve Wilkins
    Mind the Gap
    http:www.healthecommunications.wordpress.com

    • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

      Steve, thanks for the advice, but I’m way beyond the change-the-names-to-protect-the-guilty phase.

      Five years ago, I came to the blogosphere on the invitation of a local (Greensboro N.C.) newspaper Editor touting “citizen journalism”. The problem is that my story does not reflect well on one of his major advertisers (the bigger hosptial up the road that employed the doctor I “rescued”) – ergo, he has found every excuse in the world not to even LOOK at the black-&-white evidence I have.

      I repeat HE HAS NOT EVEN LOOKED. That’s not journalism.

      At this point, I want these executives PUNISHED for what they did – by the regulatory & government agencies that tell the public they’re here to protect us (patients and doctors alike). They did not give a rat’s tail about lying in order to besmerch my reputation (and protect themselve from “bad press”), and I am now not loosing any sleep about what the truth does to theirs.

      As I think I said earlier, I hope to file a lawsuit against some of those regulatory agencies by the end of the year (still a little ify). There will be a book eventually.

      Blogging has not been the answer I had hoped it would be. I think it’s a very sad commentary on blogging – especially the journalists that blog.

  • http://www.twitter.com/alicearobertson Alice

    Here’s a thought – find a blogger that focuses on the pertinent aspect of the industry, i.e., hospital, health plan, etc., and get them to tell your story without mentioning names and risking repercussions. As an old hospital Marketer, hospitals live in fear of bad press. Why not use “social media” to achieve a “social good?”

    Any other bloggers have any thoughts on this approach? [end quote]

    This approach often does work with disgruntled customers. I understand some of the bigger companies had employees who did websearches of their name and would try to settle complaints that were posted. With the downturn in the economy I am unsure if this is still happening, but I did see one blogger received a “Cease and Desist” order when he blabbed online. His response was to scan the order and place it online. He got satisfaction. Another guy received two of these orders (those orders are hard to discern…..they can be a bluff….or very serious and a civil suit is pretty expensive to launch and defend. My friends were hit with 37 page legal order that infringed on our First Amendment rights on our blog posts……it went nowhere……..but certainly was scary).

    I think the problem is that as much as Mary is hurt, others often don’t understand until it’s them. We can complain, but we do need doctors, so it’s not like complaining about a bad computer purchase online. Mary’s problem goes way beyond customer service….and in truth I am unsure……….if Mary or I were able to get someone fired for their misdeed would that be justice? I don’t want anyone’s job……..we have lives to live and people we can help. At one point I so desired an apology, but I am even over that. I am just into educating consumers, so they understand the vast amount of mistakes that are being made…….and I am flustered that there is more, and more government control (now try complaining to them when a government agency messes up. I worked for Social Security years ago and the saying was they could pass a constitutional amendment easier than they could fire some employees. Government employees are usually paid higher…….so it’s a great job on one level…….but on another level they are often inept).

    I think adversity can make us stronger and better people. I am not excusing perpetrators…but I do feel as long as we are angry at them…..in some ways they own us. Some can ask how you forgive when the offender hasn’t asked…..but you move on and just try to warn people about the perils. It would be counterproductive for my daughter to view herself as a victim, although, she does want the butterfly tattoo for a cancer survivor….but sometimes people online are strange……..she posted on a board yesterday about the tattoo and got told off pretty severely today by an embittered woman who felt her diabetes was worse…..and told to get a life. Ugh……..for a split second I was ready to hunt the poster down………but in truth, I feel sorry for someone spewing that type of vitriolic non-sense without compassion. We are just grateful she isn’t our neighbor.

    • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

      Alice, I appreciate your supportive/understanding comments. But I want/need you to understand something.

      I was in tax-payer-supported public service. I served honorably and well – going above and beyond. The executives who did me wrong work for a “non-profit”. The CEO makes close to $500,000/year now . . . while, for a time, I was relegated to making a minimum MD wage and sleeping in roach-infested hotels that he would NEVER let his daughter (if I am correctly informed, a doctor) or grandchildren set foot in.

      These executives knowingly & repeatedly lied under Oath about matters relevant to a damages claim. It’s perjury (a felony without a statute of limitations). It’s contempt. It’s fraud.

      I want them fired for cause. I want them prosecuted for their crimes (so the state of North Carolina can order restitution to me as a part of the resolution of the case – or I can sue them/the hospital afterwards). And I want the hospital sanctioned by DHHS and JCAHO. And above/beyond ALL of that I want an apology. My Father is already dead, but I’d sure like my Mom to see it.

      And believe me. If that happens, I WILL feel better.

      If just ONE (whistle-blower) case like mine got the attention it deserved from the national press, I daresay a lot of crap-currently-directed against doctors by hospitals would stop.

  • Heather

    Great point Steve. Social Media is an extraordinarily powerful tool. It has come a long way just in the past 2 years. The blogosphere does not = journalism. We no longer need newspapers or major media outlets (beholding to advertisers) to tell our story. Social media can be very effective for creating powerful positive change. The focus has to be on that though – creating positive change.

    • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

      Heather, from my view in the cheap seats (I’ve been here 5 years), social media is a very weak tool that plays (like high school) only to the most popular kids in “the class”.

      And that’s why we have who we have in the White House right now. It certainly was not about qualifications/experience.

      The biggest stories on the blogosphere are not big stories until they are picked up by the MSM.

      I’m here for both individual justice AND positive change (see my 7/5, 9:01 PM reply to Alice). I make no apologies for that.

    • http://www.twitter.com/alicearobertson Alice

      The blogosphere does not = journalism. [end quote]

      This is true, but let me say having had two children with cancer the internet is so helpful (and destructive). Years ago when your oldest had a brain tumor you had to travel down to Case Western Medical School and read through their journals. And doctors rarely did that type of research, so the patient did it. I, also, think Mary was right when she pointed towards our current leadership…….and one big cause of that was people willing to believe what is in print and the poor journalism that is out there……so even “journalists” have an agenda and even though I disagree with a writer like Christopher Hitchins I admire his honesty……same with caustic Ann Coulter…….I read them both because they do their homework, but come to different conclusions. To me honesty is more important than their philosophy, but so few seek honesty (and, sadly, that goes for doctors…….who come here and rant, then seem to tune out the very patients who could help them find coping skills….or even a desire to learn from the patients). And because our youth are on some type of public school assembly line the truth is so many of them lack discernment and go for the entertainment mindset (ever see that video where they pulled voters in 2008 out of line and asked them why they were voting for Obama? That one was a jaw-dropper…..some thought they would get to stay home and never work and get complete socialism [too bad history teachers didn't point out where socialism leads...or that if the pot goes empty who will put into it...I mean some bare bones common sense was missing], then some were honest and said they simply didn’t know. Some weren’t even able to answer who the VP would be who was on the ticket.

      Newspapers and big magazines are going under…..sure talk is cheap……but sometimes you find a nugget that can just about be a cyber-epiphany. I found Mary’s story online many months ago and found it very helpful. I wrote to her and she helped me understand the idiosyncrasies of a horrible situation that was driving me batty at the time. I remain very thankful to her for that……and it was through her blog I found her. It didn’t get printed in a national magazine, but it did get read by one desperate mom. Sometimes we just do the right thing and even if we remain unrecognized…..we rest in that……sure it’s not our vision of how it should have played out…….but keeping our integrity and the willingness to help others becomes paramount.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson
  • http://www.twitter.com/alicearobertson Alice

    Mary you are using the internet in ways that may mean your writing is cathartic? It looks a bit like dueling blogs. I have not visited the other blog, but you have me interested enough to visit. I usually stay away from blogs that practice censorship (realizing the legal responsibility a blog owner has if they don’t allow posters to delete their own posts. Is that why Kevin moderates each post? Just curious…..and trying to figure all of this medical establishment stuff out……and wavering between trust, skepticism, enlightenment, and just the humanness of it all). And enjoying the freedom I have to post (with complete honesty) without fear…..

    Whether people agree with you or not, or even believe you, if you file a lawsuit it will enter a sphere of great interest because internet law is a newer field and your online posts will be held under that scope. I think if they could have shut you up, they would have by now. Basically, other bloggers may watch for updates to see how this plays out in the legal arena, and exactly where their First Amendment rights are when it comes to exposing doctors (or anyone….my friends and I were exposing false ministries and, ultimately, the Constitution wins out for now…..but with voters voting without understanding the great privilege and responsibility that comes with that vote who knows what future judges we will have rewriting the Constitution?)

  • jo

    I will take the surgeon with horrible bedside manner but is excellent in the OR, over the surgeon who is all warm and fuzzy, and “serves” me well, but leaves a towel in me because his focus and priorities are misplaced.

    This goes for any physician who is worth their salt. I am not seeing them to get a pat on the back (I go to church for that) I go to them for great diagnosis and treatment. Period.

    Isn’t it funny that we pay most of them less than a car mechanic, but expect them to also stroke our ego, hold our hand and be there 24/7 for any question that just happens to pop i our heads and take our abuse when we have a bad day, but won’t allow them the same courtesy.

    This madness is not expected of any other secondarily educated professional.

  • http://www.twitter.com/alicearobertson Alice

    Isn’t it funny that we pay most of them less than a car mechanic, but expect them to also stroke our ego, hold our hand and be there 24/7 for any question that just happens to pop i our heads and take our abuse when we have a bad day, but won’t allow them the same courtesy. [end quote]

    You said you go to church for a pat on the back…….so you wouldn’t mind if the preacher preaches on charity, then slaps you on the back on the way out? People just think they will switch skill for arrogance, because courtesy is part of their skill. An arrogant doctor is rarely as good as he thinks, and has often patted themselves on the back so hard their hands are no good for surgery!

    I think when patients rally around this either/or philosophy (which in reality they would rarely accept. Let a surgeon tell them their child is fat, or undisciplined, and see how much they defend the doctor), they perpetuate bad behavior……..and most doctors don’t like to hear that their colleagues are behaving badly on a humane level. Cleveland Clinic is now into the whole person aspect of treatment/healing and asking their doctors to treat people with courtesy and respect because that’s the minimum a person seeking counsel should expect.

    We would not tolerate bad behavior from a teacher, preacher, or sales clerk, so why on earth would we defend doctors with attitudes against the very people they claim they will do no harm? So emotional harm is now fine? In the name of skill? I think that’s a bit oxymoronish as far as the healing philosophy goes.

  • jo

    Point well taken, though some do not see that if you abuse a dog long enough it will bite the hand that feeds it. Physicians especially primarys have been long abused and sometimes the better they are the more they are taken advatage of. At some point there is going to be some blow back.
    This is all the fall out of and frustration of a broken system then those that promised to fix it broke it further and that trickles down.
    I agree some physicians, very good ones can have bad attitudes not only to patients but peers as well.

    Mine happens to be a good guy, the kind that listens well beyond the point of payment, and is also taken advantage of by his associations, acedemia, the hospitals he is associated with, the speicalists that he refers patients to. I see patients get up walk out, get mad not because of bad attitude or bad doctoring, but just because they had to wait a little long for their appointment.
    Maybe doctors need to have it all together, never be late, never have a bad day, I just wonder in this society that feels so entitled to have it their way all the time if patients should also feel some responsibility to “play nice” as well.

  • http://www.twitter.com/alicearobertson Alice

    Thanks for understanding what I was trying to say. Sometimes I type on my cellphone and when it’s posted (and I can actually see it) I am horrified!

    I agree some doctors are abused by patients. The doctors I know tend to see it as part of their job (I imagine doctors in psyche wards have some wild stories about their patients. Our daughter is a nurse and they get attacked sometimes by patients and verbally by doctors….but this is rare). Our doctor said he offers the unruly patients a switch in doctors, and thankfully, they usually take it (I am like you and can’t imagine anyone treating this doctor in that manner. He certainly isn’t perfect, but I call him the protype of what a doctor should be like. I wrote on this blog that we “adore” him and then sent him the link. He gets a laugh out of my dramatics).

    Pesky humans…….and, yet, I just marvel at the open dialogue here. I think doctors have much bigger problems than the occasional tyrannical patient….because surely the face of medicine is changing dramatically. We certainly aren’t in Kansas anymore………….:)

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